What happens to Mentally Ill People who are thrown in jail due to side-effects of their medications?

In December, 2009, NC Medicaid began requiring an additional tier of pre-authorizations for many medications. This simply resulted in an increase in the use of emergency services and caused the police to be engaged for mental health events bought on by mental health care deficits.

Overlapping with this matter, within the past year, the Centers for Medicare and Medicaid Services have been approving the use of telemedicine (the psychiatrist is not local and a video cam is utilized). This is a good idea but loses significant effectiveness if the local provider cannot interface with the telemedicine end of things. Continuing cuts in public mental health causes loss of providers and since necessity is the mother of invention, telemedicine was certainly something to be considered. At this time, the Balsam Center, associated with Smoky Mountain Center LME, is considering bids for telemedicine contracts.

Recently, a client of mine with a well known (to the local police and hospital) mental health challenge was taken to the Hazelwood jail facility where she was left for five days without any of her medication; this endangered her life. Prior to this event, she had been taken to the local emergency room where she was dismissed as ‘drug seeking’ due to a chronic pain condition which could not be treated by her primary care provider efficiently due to the NC Medicaid prior authorization demand, causing her to be without her non-narcotic medication for weeks.

At the Hazelwood jail in Waynesville, collect calls are apparently very expensive (thus, family members cannot become involved); the heat is shut off come bed-time at the jail; drinking water comes from the top of the toilet. Such treatment is even worse than what occurred last winter at Haywood Regional Hospital when the mentally ill man was chained to the hospital gurney for days before a mental health hospital bed could be found. The jail nurse saw my client exactly five days after she was admitted there and she saw no medication until her sister-in-law bailed her out.

When the police were called due to she throwing a salt shaker at her 17 yr old son due to the ‘unfortunate’ delusional side effects of Thorazine which had been prescribed for sleep by the Balsam Center telemedicine psychiatrist (this psychologist advised that psychiatrist’s nurse of worrisome side-effects of the Thorazine four days prior to the police being called), the client was advised by the police not to take her purse or meds with her. She was rebuked by the police due to her slurred speech and ‘Thorazine shuffle. ’ DSS was engaged due to her son being a minor.

She has never been in jail before but her bond was held in place by the court without any apparent attempt to consider her history of mental illness and multiple admissions which are not unrelated to the medication boondoggle created by NC Medicaid’s attempt to curtail usage.

Each time an ambulance is called it costs Medicaid about $500. Emergency admissions cost a lot more. When the police are called, they necessarily are not able to respond to other demands. NC Medicaid would do well to consider the strain that additional paperwork is creating such that psychiatrists are lost and providers in the community have less time to work with patients due to being demanded to fill out more paperwork.

Paperwork is nothing other than an attempt to truncate services by burying the providers so that they will not render services----or simply quit or avoid working with certain populations of citizens needing health care. Additionally, a refresher course regarding how to best work with citizens with known mental health challenges seems to be in order as regards the local Haywood County police.